Lymphatics and blood vessels.

The traditional nomenclature of vascular lesions has been enlarged and modified with the usage of newer diagnostic techniques. Digital technology has enhanced the precision of older analog tools such as Doppler flow studies. Angiograms have also more precisely delineated flow patterns to allow planned surgical intervention as an important therapeutic option. With the newer classification, it now is possible to plan and anticipate the course of lesions and medically intervene in tumors that potentially will enlarge and impinge on essential structures. Now, the routine workup will clarify if there is internal involvement (eg, liver, etc) and detect proliferative potential mandating medical or surgical intervention. Watchful waiting, the traditional approach is now changing with the newer delineation of syndromes such as PHACE (posterior fossa, hemangioma, arterial lesions, cardiac abnormalities/aortic coarctation, eye abnormalities), which mandate the fullest evaluation and, in many instances, the collaboration of multispecialty groups to treat those lesions as the data and group consensus determines.

Current concepts in systemic and topical therapy for superficial mycoses.

There presently exists a wide selection of choices in the treatment of superficial mycoses. The main categories of broad-spectrum agents are the allylamines and imidazoles, which have been tried and proven over more than 2 decades of usage with good safety. Nystatin and griseofulvin have even longer experience of about 5 decades but have niche usage for yeasts and dermatophytes, respectively. Although no new therapeutic groups have appeared, extensive development of vehicles and delivery systems has enhanced therapeutic results and increased patient compliance.

Life-threatening dermatoses in travelers.

Life-threatening dermatoses in travelers relates to infections, or allergic or drug reactions. Of the infectious dermatoses, most are parasitic or viral- because of the short time frame. Bacterial infections usually have a longer incubation. More significant are allergic reactions from environmental or dietary causes, and drug reactions, especially those drugs taken for prophylaxis from tropical diseases. All of these can be fulminant and therefore an awareness and early therapeutic intervention is mandatory.

Rosacea as an inflammatory disorder: a unifying theory?

Rosacea is increasingly being viewed as an immune-based disorder. Various immune factors, such as eicosanoids, proinflammatory cytokines, and polymorphonuclear leukocytes, appear to be involved in the vascular, inflammatory, and proliferative subtypes of this disorder. Many pharmacologic agents that effectively treat the symptoms of rosacea show anti-inflammatory and/or immunomodulating effects, providing further evidence that rosacea is an inflammatory disorder.

The treatment of rosacea.

The roundtable discussion encompassed many topics-from seminal research by Ronald Marks to the latest National Rosacea Society-funded studies on the pathophysiology of rosacea. All participants commented on the value of the new National Rosacea Society classification system for subtypes of rosacea, designed to direct future research and help physicians better diagnose and manage these subtypes. A lively discussion centered on treatment options for the various subtypes of rosacea ensued.

Alternative therapy in pruritus.

Because of its multitude of origins, the symptom complex of pruritus has a plethora of purported remedies and few therapeutic indications. Very few topical and systemic FDA approved medications have the indication of pruritus. Specific therapy still awaits a better definition of the exact physiologic events in chronic pruritus. Hence most medications actually focus on the central nervous system--the peripheral receptors--and the lack of specific physiologic targets has inhibited pharmacologic development. The resulting gap has opened the door to a variety of alternative therapies.

The rationale for using a topical retinoid for inflammatory acne.

Both comedogenesis and the development of inflammatory lesions in acne vulgaris appear to be related to genetic as well as immune processes. The key regulatory cytokine, interleukin-1alpha, has recently been documented as playing a major role in both the hypercornification and the orchestration of immune factors, ultimately resulting in noninflammatory and inflammatory lesions. Topical retinoids, such as tretinoin, and topical retinoid analogs, such as adapalene and tazarotene, help normalize the abnormal follicular keratinocyte desquamation - a key pathophysiologic factor in comedogenesis. This normalization also helps mitigate against the development of a propitious microenvironment for Propionibacterium acnes. Preclinical data suggest that topical retinoids and retinoid analogs may also have direct anti-inflammatory effects. A wealth of clinical data confirms that topical retinoids and retinoid analogs significantly reduce inflammatory lesions. Comparative clinical trials also demonstrate that adapalene has the best cutaneous tolerability profile of all these agents. Optimal therapy for inflammatory acne would involve the use of topical retinoids or retinoid analogs combined with oral or topical antibacterials.